When Craig Harper woke up on February 5, 2019, he was deaf in his left ear. An audiologist told him he had permanent nerve damage and would likely never get his hearing back. But nerve damage didn’t explain the headaches or the intermittent fevers soaring to 103°. The steroids prescribed by Craig’s family doctor, intended to treat fluid buildup behind the ear drum, weren’t helping. Next came spasms of back pain so severe they put Craig on the floor. After an ambulance ride to the emergency room came a CAT scan, an MRI, a flu test, and blood work. None of this helped the doctors diagnose or treat the cause.
The next day was Saturday, February 9, and Craig – whom you probably know as Dr. Craig Harper the Extension Wildlife Specialist with the University of Tennessee – was supposed to help with a National Deer Association (then known as QDMA) habitat work day in Athens, Georgia. Upon leaving the hospital on Friday, Craig’s wife Theresa drove them to Athens for the event. Somehow Craig led participants in lighting and managing prescribed fires. I was there, too, yet Craig didn’t let on to any of us at the event that he was fighting a fever of 102°. Pictures I took that day show Craig grinning while running a chainsaw and burning woods.
That evening, Theresa drove Craig back to their home in Maryville, Tennessee. His fever climbed. “I was in bad shape with high fever, and I felt terrible,” said Craig. “I had extreme night sweats and would wake up as wet as if I had jumped in the river.”
While Craig struggled to rest, Theresa got on the Internet and worked through the night researching the symptoms. With a stack of printed evidence in hand, she woke Craig at 6 a.m. and pronounced a diagnosis. Theresa believed Craig had brucellosis, a bacterial infection usually transmitted to humans from several species of animal hosts, including wild pigs.
“We went back to the hospital,” said Craig. “They agreed that I could have brucellosis and put me on two antibiotics, doxycycline and rifampin. My hearing gradually returned after two weeks. Thank you, God!”
Still, the diagnosis wasn’t certain since the facility couldn’t test for brucellosis. Craig’s doctor referred him to an infectious disease specialist, but getting an appointment was not easy. Craig would finally see a specialist in North Carolina on April 22, two and a half months after the onset of symptoms. While he waited to see the specialist, Craig continued to fight fever, night sweats, weakness and lethargy, though the symptoms slowly improved. While still on medication with periodic fever, he assisted with a Level 2 Deer Steward course in Missouri, traveled to Australia, killed fallow deer and hog deer, and killed two gobblers when he got home, all before getting a final diagnosis of toxoplasmosis and brucellosis from the infectious disease specialist in late April.
“If you get a puncture wound while you’re handling an animal, clean the wound immediately and bandage it. Cleaning a wound quickly after coming in contact with deer blood is very important, so have those first-aid supplies in place.”
Dr. Mike von fricken, university of florida one health center
Where did Craig get these diseases? He and his doctor have a likely theory: “I helped a property manager in Mississippi kill a bunch of feral hogs in a corral trap on January 28, 2019,” said Craig. “Blood from one of the hogs splashed in my face. I paid no attention to that other than wiping it off my face. In retrospect, my doctor and I suspect some of the blood likely got into my eye or mouth.”
That would do it. Wild pigs are known and likely carriers of both toxoplasmosis and brucellosis, as well a few other things like leptospirosis. According to the Centers for Disease Control and Prevention, one way to acquire brucellosis is “getting body fluids from infected animals in the eyes, nose or mouth.” The disposable gloves Craig wore to dress the pigs he killed were a great idea, but it was too late. His first symptoms appeared six days later.
Hunters are exposed to many health threats in the outdoors. Zoonotic (animal to human) diseases like brucellosis can be transferred in blood. A mosquito bite can deliver West Nile virus. Ticks can transmit many different diseases and even a red-meat allergy. And eating undercooked venison can lead to toxoplasmosis or a bacterial infection like E. coli or salmonella. Craig’s story encapsulates many of the problems with diagnosing these outdoor-enthusiast infections.
Physicians Think Broadly, Unless You Help
From the start, Craig’s doctors weren’t thinking “outdoors” when they first examined his symptoms. To them, Craig was just like any other patient. That’s why you need to remind yourself, and your doctor, that outdoor activities carry disease risks. Craig never thought about or mentioned the wild pigs until Theresa suggested brucellosis. If you are not well, consider all your recent activities and travels.
“The doctor can ask a lot of questions and still not figure out what’s going on if the patient isn’t offering the right information,” said Dr. Mike von Fricken, director of the University of Florida’s One Health Center. The Center works to increase collaboration between human, animal and environmental health disciplines to better fight spillover diseases.
Symptoms Overlap
Many of the symptoms of zoonotic diseases like brucellosis and Lyme disease – fever, aches, malaise – are shared by numerous common diseases like flu. The common diseases will be your doctor’s first suspects, unless you help them.
“These are uncommon diseases,” said Mike. “Doctors have their checklist of the most common causes of disease. Sometimes they just get lucky. They suspect a bacterial infection, they give you a full course of doxycycline, you recover, and that’s the end of the story. Sometimes they never figure out what an individual has. The patient gets better, and no one has the time to go back and try to figure out what they had.”
Testing Isn’t Comprehensive
Broad-spectrum blood testing at many hospitals and doctor’s offices cannot screen for or catch uncommon diseases like brucellosis. “You have to know what you’re testing for,” said Mike. “Some of these rare diseases require specialized testing, and sometimes it’s a different specimen – blood, stool, a nasal swab – for different tests.”
Infectious Disease Specialists May Not Help
As Craig found, infectious disease specialists are not numerous or easy to see. According to Mike, many of them work in hospitals where they focus on hospital-acquired infections.
“Finding someone who is a true specialist in some of these diseases can be difficult,” said Mike. “When you get a zoonotic disease like brucellosis, that’s going to be pretty low down the list of even what an infectious disease doctor would think of.”
Diagnosis Errors Waste Time and Treatment
Until Theresa conducted her own investigation, doctors’ diagnoses and treatments were heading down the wrong path. Craig’s hearing was not permanently damaged. Steroids weren’t going to help. This is why, as the headline of this story tells, you should always inform your doctor about your outdoor pursuits when you’re dealing with mysterious or difficult health problems.
Be Your Own Advocate
“A doctor might have 15 or 20 minutes with you, max. There’s only so much time you have as a patient to advocate and provide information,” said Mike. “You want to avoid falling into the Web MD trap, so don’t diagnose yourself. The doctor is there, let them think. But what you can do is be vigilant about when your symptoms started, what have you been doing, where have you traveled, who else have you been around. Be ready to provide the symptoms, patterns and information, like saying ‘I’m a hunter’.”
Mis-diagnosis of wildlife- and outdoor-related diseases is so common, the USGS National Wildlife Health Center created a medical alert wallet card for wildlife professionals to carry. It alerts medical personnel that the carrier of the card could have been exposed to a zoonotic infection and lists several potential diseases.
An Ounce of Prevention
“Most hunters know about preventing ticks and mosquitos, but you should also use caution during the butchering of your kills,” said Mike. “Make sure you wear heavy duty disposable gloves. If you get a puncture wound while you’re handling an animal, clean the wound immediately and bandage it. Cleaning a wound quickly after coming in contact with deer blood is very important, so have those first-aid supplies in place.”
Because there’s a long list of potential diseases and infections you could acquire while hunting, there’s a lot to say about prevention. The American Veterinary Medical Association put together an excellent list of disease precautions for hunters here.
But if prevention fails, remember to be your own advocate. Tell your doctor you process wild game by hand, eat wild meat that is sometimes cooked on the rare side, and spend a lot of time wading through tick-infested cover and mosquito-plagued swamps. This extra information might just be the clue they need to pinpoint the disease or parasite you dragged in from the woods.
A Note About CWD: When writing about deer and diseases, it seems strange to skip over the most significant deer disease of all, chronic wasting disease (CWD). But there is no evidence, despite years of investigations, that CWD has ever spilled over from deer to humans. Nevertheless, experts advise caution and prevention. If you hunt in a CWD zone where the disease has been found in deer, submit your harvested deer for testing. Do not consume the venison from a deer that tests positive for CWD.